Health systems are checking on patients digitally

But hospitals stress that human element is still critical piece

After discharge from University Hospitals, a patient with chronic obstructive pulmonary disease receives a call checking in: How many times have you used your rescue inhaler in the past 24 hours? Are you feeling better or worse than yesterday?

The automated call lasts just a couple of minutes, provides the patient with some information about inhalers and ends with this message: “All right. Thanks for listening. I'll check in on you again in a few days. Goodbye.”

And the computer will.

This transition of care program at UH Geauga Medical Center sends a series of calls to recently discharged patients with COPD for about two weeks. If a patient's responses are concerning, providers will be notified so they can follow up. The automation is an offering of Emmi, which designs technology-based systems that deliver patient engagement.

As technology offers growing ways to interact with patients, hospitals are working to increase efficiencies without losing the personal touch of a patient-physician relationship.

It can be done, but it takes work to walk that line between added efficiencies and empathy, said Carol Santalucia, president of Santalucia Group, a Cleveland consultancy focused on patient experience.

UH uses Emmi for this automation service as well as for educational videos and population health campaigns.

MetroHealth plans to start using Emmi's automated calls this summer, in addition to the other Emmi features it already uses. After a six-month pilot, the Cleveland Clinic is using HealthLoop — which sends automated emails to patients — on an ongoing basis in orthopedics. It's open to expanding that service to other departments.

“I think technology can help us become much more efficient, and I also think you have to be very, very careful with it,” said Santalucia, who spent almost 30 years at the Clinic working in patient experience before starting her consulting firm.

“The thing that I encourage health care leaders to do and to recognize is that it's all about that emotional connection,” she said. “And it's harder to achieve the emotional connection when you rely too heavily on technology.”

“We're never trying to over-automate or take away that personal touch, especially in a space like health care,” he said.

Personalizing automation

At UH, a discharge team evaluates a patient's needs and then tweaks the generic follow-up call plan for whatever procedure they had.

A patient may need fewer calls or more, or perhaps should be called manually.

And patients can always access a live person if they'd prefer. Before Emmi, those post-discharge calls would have been manual — and therefore far less frequent.

Matt Stanton, who leads the HealthLoop pilot at the Clinic, said the automated emails definitely offer more communication.

“There's just no way that a surgical team could call every single patient every single day to check in on them,” he said. “But this is one way in which we can, in some way, check in on every single patient every single day.”

The added volume of check-ins gives hospitals more opportunities to detect potential problems. Certain concerning responses from a patient would trigger an alert, letting providers know they should reach out.

For instance, if a patient reports on HealthLoop they have some swelling and redness at a surgical site, someone at the Clinic could follow up and ask them to upload a picture.

Santalucia, who has seen more and more technology in patient engagement, said this follow-up step is key.

Automated emails and calls have a critical role, and it's where things are headed, she said, but it's important that people still understand empathetic communication.

“I think you have to be careful not to see it as an empathetic interaction.

“It's an automated interaction that maybe can help us understand where we need to respond in a more empathetic way,” she said.

Dr. Adrienne Boissy, chief patient experience officer at the Clinic, said too often, engagement is looked at from only the patient viewpoint, but she argues that the goal should be to have both the patient and the physician engaged.

“If you have highly engaged patients but providers who are half engaged, I don't think we've achieved what we were hoping for,” she said.

Technology can be a way to extend the relationship between the two, but it needs to be implemented in a way that maintains meaning and keeps in mind the fact that one technology solution won't meet everyone's needs.

Education and outreach

Beyond automation, engagement through these systems and others offers a lot of chances to educate patients.

MetroHealth recently began using the Emmi system to send educational multimedia to patients. The Emmi presentations cover everything from how a procedure works to what to expect in the hospital to details about a condition. It allows patients to rewatch parts they want to understand better or pass the videos and presentations along to caregivers and family members. UH has been using this service as well and helps Emmi build its library with content from experts at Case Medical Center.

It's important to reach patients where they are, said Dr. Sara Laskey, head of patient experience department at MetroHealth. That may be on their smartphone through an educational video, or it may be over the phone.

Some Clinic doctors have started using HealthLoop to parse out pre-procedure information. In the past, providers would hand patients a large binder that can be intimidating, difficult to digest and probably doesn't get read all that much, Stanton said.

Now, HealthLoop sends a series of emails spreading out that information.

“It's not necessarily clear to us whether this is a better way necessarily, or more effective, or if it has a measurable impact on outcomes, but parsing out the information and providing it at the right times intuitively seems like a better way to do this rather than just handing them the binder,” Stanton said.

How to measure patient engagement through technology is one of the next steps. Boissy said it's important to distinguish between engaging in technology and engaging in your health care.

“Just because you monitor your numbers on your iPhone or you check in every once in a while, does that mean your outcomes are going to be different?” she said. “I don't know that we know the answer to that yet.”

The challenge remains finding the best way to connect with patients. Technology can be a tool in that, but Boissy said she never wants to see a day when heavy, important, dense information is shared in an email.

“Connection is universal. How you achieve it and what that looks like in different people's eyes is different,” Boissy said. “It boils down in some sense to effective communication, which may sound like a less-sexy answer but actually may be the most innovative thing we can do, which is keep honing our ability to communicate empathy and compassion effectively.”